妊娠期高血压疾病课件

单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,Your company slogan,Hypertensive Disorders in Pregnancy,Teng,YinCheng,Shanghai,Jiaotong,University Affiliated Sixth Peoples Hospital,Dept of,Obs,&,Gyn,Contents,E,tiology&Pathogenesis,Clinical features,Physiopathology,Classification,Diagnosis,Management,2,3,4,5,6,1,Incidence and Risk Factors,Incidence,Commonly about 5 percent,Markedly influenced by parity,Related to race and ethnicityA genetic predisposition,Main Risk Factors,Nulliparous,(,初产妇,),Multiple pregnancy,History of chronic hypertension,Maternal age over 35 years,Obesity,Lower socioeconomic status,Roberts,J.M.et al.Hypertension 2005;46:1243-1249,Used with permission,Two-stage model of the pathophysiology of preeclampsia,Stage 2 develops in some,but not all women with stage 1,Etiology and Pathogenesis,Etiology and Pathogenesis,Normal:,vessel,remodeling(,血管重铸,),of the,decidua and myometrium,transforming into,large-capacitance,low-resistance,vessels,Preeclampsia:,incomplete remodeling,limited to the,superficial decidua,myometrial segments remain,narrow,Faulty,Placentation,(,胎盘形成不良,)-Stage I,Etiology and Pathogenesis,Oxidative distress,（氧化应激）,Incomplete vessel remodeling Reduced placental perfusion placenta ischemia,（缺血）,and hypoxemia,（缺氧）,Oxidative distress Endothelia dysfunction affected production of,Nitric Oxide/,Prostaglandins,（前列腺素）,Other factors,Immune system dysfunction,Genetic predisposition,Malnutrition,Pathogenesis of preeclampsia,G,enetic factors,immunological,factors,Maternal vascular disease,Environmental,factors,R,educed uteroplacental perfusion,Faulty placentation,Endothelial activation,Systemic vascular dysfunction,C,apillary leak,vasospasm,Hypertension,Cerebral edema(eclampsia),Edema,Proteinuria,Coagulation abnormalities(HELLP),Fetal growth restriction(FGR),Physiopathology -,sgage,II,Basic change:,System Vasospasm,（全身小动脉痉挛）,H,emorrhage,edema,hyperemia,充血,thrombosis,Visual disturbances:blurred vision,blindness,retinal detachment,（视网膜脱落）,Reduced renal perfusion and,glomerular,filtration,肾小球滤过率,Proteinuria;increased uric acid;,oliguria,Ischemia,edema,elevated serum,transaminases,(ALT,AST,AKP.);jaundice,（黄疸）,Subcapsular hematoma(,肝包膜下出血,)or hepatic rupture,Physiopathology,Peripheral vascular resistance,cardiac output(,低排高阻,),blood pressure,Cardiac failure(,心力衰竭,),pulmonary edema(,肺水肿,),Blood volume,hematocrit (HCT,红细胞压积,),blood concentration,H,ypercoagulability,(,高凝,),thrombocytopenia(,血小板减少,),Placental ischemia and hypoxia,High-resistance circuit with decreased blood,Fetal growth restriction,fetal distress(,胎儿窘迫,),Clinical manifestation,Hypertension,Edema,Proteinuria,Severe cases,H,eadache,blurred vision,nausea,vomit,right upper quadrant pain,seizure(,抽搐,),Usually occurs after 20 gestational weeks,WHAT LINKS STAGE 1&2?,Theory exploration:,Genetics/Abnormal lipid metabolism,Endocrine dysfunction,Inflammation,Not all women with reduced placental perfusion develop,preeclampsia,What links stages 1 and 2?,Reduced placental perfusion must,interact,with maternal factors to result in,preeclampsia,.,Stage 1,?,Stage 2,Roberts,J.M.,Gammill,H.S.(2005),Diverse manifestations are possible:maternal and fetal/placental factors may vary in proportion.,In a woman with,many,predisposing factors,even a minor reduction in placental perfusion is sufficient for stage 2 to develop.,In a woman with,few,predisposing factors,a profound reduction in placental perfusion may be required for,preeclampsia,to develop.,Roberts,J.M.,Gammill,H.S.(2005),Predisposing factors,Reduced placental perfusion,Microsoft Office 2000,Could maternal genetics play a role in the link between stage 1&2?,Stage 1,Stage 2,Genetics,What do we know?,We know that abnormalities in lipid metabolism have a genetic basis.,We have learned that,preeclampsia,is characterized by profound lipid abnormalities such as,hypertriglyceridemia,Gratacos,E.(2000),Microsoft Office 2000,Could abnormal lipid metabolism be a genetic factor linking the stages of,preeclampsia,?,Stage 1,Stage 2,Abnormal lipid metabolism,Preeclampsia,is characterized by metabolic abnormalities similar to those present in atherosclerosis:,Hypertriglyceridemia,Reduced HDL cholesterol,Predominance of small-dense LDL cholesterol which have an increased potential to cause endothelial cell damage as compared to larger,more buoyant,LDLs,.,Gratacos,E.,2000.,Stage 1,Abnormal lipid metabolism,Stage 2,In the presence of oxidative stress and inflammation,susceptible small-dense lipoproteins may be more easily oxidized,triggering Stage 2,maternal disease.,+,Oxidative Stress,+,Inflammation,Gratacos,E.,2000,Most of the suggested linkages could contribute to or be stimulated by oxidative stress.,Oxidative stress is proposed as relevant to many diseases.,Evidence supports the presence of oxidative stress in,preeclampsia,:,Protein products of oxidative stress present in maternal and fetal tissues,Antibodies to,oxidatively,modified,LDLs,present in maternal and fetal tissues,Concentrations of certain antioxidants re